Kids at Westmead go virtual for diabetes

A pioneering telehealth initiative is helping kids with diabetes in regional areas – and assisting clinicians to see more patients in less time. Josh Gliddon reports.

The Challenge: To replace on-site visits to diabetic kids in regional areas with teleconsults.

The Approach: Clinicians at the Childrens Hospital at Westmead, and at the regional centre, connect using Microsoft Lync to monitor children with diabetes.

The Outcomes: Clinicians can see more patients, and the results are stored electronically for comparison over time.

The Lessons Learned: The environment for a teleconsult must be just right – good lighting, and good quality sound and images. Also, teenagers love teleconsults.

The Upside for:

Clinicians: Are able to see more patients, and are not wasting time in transit.

Patients: Can have their needs attended to closer to home.

The Organisation: Is able to make better use of clinician time, along with caring for more patients.


The TeleDiabetes story

Diabetes is an insidious disease. Patients with type-1 diabetes must have a constant external supply of insulin in order to stay alive. It’s even harder for kids, who must either inject themselves with insulin, or wear an insulin pump the size of a smartphone.

It’s also a challenge for doctors monitoring diabetic kids, particularly those youngsters living in rural and remote areas. In the past, said Professor Kim Donaghue, head of endocrinology at the Childrens Hospital at Westmead (CHW), clinicians would hitch a ride with the Royal Flying Doctor Service (RFDS) and conduct local clinics in places such as Orange, Dubbo and Bathurst.

“That had several disadvantages,” Prof Donaghue told eHealthspace.org. The disadvantages included the need to displace doctors from their offices while the specialist consultation with the diabetic child was taking place, through to the shift from RFDS flights to commercial services in the 1980s.

“Sitting in an airport waiting for a flight isn’t a good use of a clinician’s time,” observed Prof Donaghue.

In recent years, the CHW has made a fundamental shift away from putting clinicians on commercial flights towards the use of teleconferencing. The CHW currently serves six communities with its TeleDiabetes service. Along with Orange, Dubbo and Bathurst, it is also looking after Lismore, Ballina and Nowra.

Many clinicians are currently using Skype to perform teleconsultations. CHW avoided this software, with its questionable security and often-poor image quality, opting instead for Microsoft Lync (Skype is also owned by Microsoft, however it is a consumer-grade system). Lync is a comprehensive unified communications suite which integrates with Microsoft Office, and offers video conferencing, along with instant messaging, presence and high levels of security.

The security aspect of Lync is critical to maintaining patient privacy, she said.

Getting started with the new system was relatively easy, and several lessons were learned. “We had quite a few practice sessions with clinicians at either end,” said Prof. Donaghue. These sessions lead to the clinicians getting dual screens, and the discovery lighting was important. “You have to have the blinds closed,” she said.

Patients – or their parents – are able to download data from the insulin pump, which is used by approximately 45 percent of the juvenile patients the service consults with. The remainder are still using traditional needle injections.

The results from the pump, or from logs kept by the patients, are emailed to the clinician at Westmead. When a child comes to the regional centre for a teleconsult they are often joined by dieticians and nurse practitioners, as well as the GP. Educators and other staff sometimes also join the consultation at the Westmead end.

“We’ve had very positive responses from the patients and their parents,” said Prof. Donaghue. “The teens in particular love it.”

Clinicians are also positive about the teleconsults. It means more time seeing patients, and less time waiting around at airports, she said. Overall, the system is more efficient, and offers the same quality of care as in-person visits.

However, there’s one area which hasn’t yet met the digital age. When the consult is over, the endocrinologist at Westmead sends a letter back to the patient’s doctor in the regional centre. The letter still goes via snail mail.